The Diagonal Vector (DIVE) Approach for Lumbar Plexus Block - A Comparison with Chayen's Technique.

Area of Science:

• Anatomy
• Regional Anesthesia
• Medical Education

Background:

• Anatomical landmark knowledge is crucial for lower limb regional anesthesia.
• Ultrasound guidance is increasingly used, but traditional landmark techniques remain relevant.
• The diagonal vector (DIVE) technique is theoretically proposed to offer advantages over existing methods like Chayen's approach.

Purpose of the Study:

• To compare the clinical applicability, accuracy, and risk profile of the DIVE technique versus Chayen's approach for lumbar plexus blocks.
• To evaluate the spatial nerve approximation and complication rates associated with each technique.

Main Methods:

• Lumbar plexus block was performed bilaterally using Chayen's technique and the DIVE method on 34 embalmed human bodies.
• The target area was the posterior medial half of the psoas major muscle.
• Anatomical landmarks were identified, photographed, and analyzed using computer-aided methods to assess puncture success, nerve proximity, and complications.

Main Results:

• Both techniques demonstrated similar success rates for hitting the psoas muscle (Chayen: 86.3%, DIVE: 82.8%).
• DIVE punctures were significantly more localized within the medial third of the psoas muscle (p<0.001).
• The risk of vessel or kidney puncture was comparable between the two methods (p=0.473 and p=0.367, respectively).

Conclusions:

• The DIVE method provides higher puncture accuracy for lumbar plexus blocks compared to Chayen's technique.
• The DIVE block has comparable practicability and risk profile to Chayen's technique.
• Optimal puncture targeting for the DIVE block is estimated to be between one-quarter and one-third of the distance from the posterior superior iliac spine to the spinous process of lumbar vertebra 3.